Journal Article > LetterFull Text
Int J Tuberc Lung Dis. 2021 May 1; Volume 25 (Issue 5); 409-412.; DOI:10.5588/ijtld.21.0010
Mohr-Holland E, Daniels J, Douglas-Jones B, Mema N, Scott V, et al.
Int J Tuberc Lung Dis. 2021 May 1; Volume 25 (Issue 5); 409-412.; DOI:10.5588/ijtld.21.0010
Journal Article > ResearchAbstract Only
Int J Tuberc Lung Dis. 2021 September 1; Volume 25 (Issue 9); 696-700.; DOI:10.5588/ijtld.21.0125
Murphy RA, Douglas-Jones B, Mucinya G, Sunpath H, Govender T
Int J Tuberc Lung Dis. 2021 September 1; Volume 25 (Issue 9); 696-700.; DOI:10.5588/ijtld.21.0125
The wider availability of dolutegravir (DTG) containing HIV therapy for patients living with multidrug-resistant TB (MDR-TB) presents several advantages. DTG-based antiretroviral therapy (ART) has superior potency, reduces pill burden, and may reduce overall treatment-related toxicity, giving it the potential to improve outcomes in both diseases. While the uptake of DTG-based ART in programs where drug-resistant TB is treated remains unknown, there is early evidence from three programs that uptake is increasing. The use of DTG-based ART should be scaled-up, beginning with antiretroviral-naïve or virologically suppressed patients initiating MDR-TB treatment.
Journal Article > LetterFull Text
Int J Tuberc Lung Dis. 2021 July 1; Volume 25 (Issue 7); 587-589.; DOI:10.5588/ijtld.21.0051
Douglas-Jones B, Mohr-Holland E, Mema N, Mathee S, Mathews G, et al.
Int J Tuberc Lung Dis. 2021 July 1; Volume 25 (Issue 7); 587-589.; DOI:10.5588/ijtld.21.0051
Journal Article > ResearchFull Text
Open Forum Infect Dis. 2023 February 21; Volume 10 (Issue 3); ofad087.; DOI:10.1093/ofid/ofad087
Apolisi I, Cox HS, Tyeku N, Daniels J, Mathee S, et al.
Open Forum Infect Dis. 2023 February 21; Volume 10 (Issue 3); ofad087.; DOI:10.1093/ofid/ofad087
BACKGROUND
Children and adolescents with household exposure to multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) are at high risk of developing TB disease. Tuberculosis preventive therapy (TPT) is recommended, but programmatic experience is limited, particularly for adolescents.
METHODS
We conducted a prospective cohort study to describe MDR/RR-TB diagnosis and TPT provision for individuals aged <18 years with MDR/RR-TB exposure. Participants were assessed for TB either in homes or health facilities, with referral for chest x-ray or specimen collection at clinician discretion. The TPT regimens included levofloxacin, isoniazid, or delamanid monotherapy for 6 months, based on source patient drug-resistance profile.
RESULTS
Between March 1, 2020 and July 31, 2021, 112 participants were enrolled; median age was 8.5 years, 57 (51%) were female, and 6 (5%) had human immunodeficiency virus. On screening, 11 (10%) were diagnosed with TB: 10 presumptive MDR/RR-TB and 1 drug-susceptible TB. Overall, 95 (94% of 101) participants started TPT: 79 with levofloxacin, 9 with isoniazid, and 7 with delamanid. Seventy-six (80%) completed TPT, 12 (13%) were lost to follow up, and 7 (7%) stopped TPT early due to adverse events. Potential adverse events were reported for 12 (13%) participants; none were serious. There were no further TB diagnoses (200 days median follow up).
CONCLUSIONS
Post-MDR/RR-TB exposure management for children and adolescents resulted in significant MDR/RR-TB detection and both high TPT initiation and completion. Tuberculosis preventive monotherapy was well tolerated and there were no further TB diagnoses after initial assessment. Key factors supporting these outcomes included use of pediatric formulations for young children, monotherapy, and community-based options for assessment and follow up.
Children and adolescents with household exposure to multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB) are at high risk of developing TB disease. Tuberculosis preventive therapy (TPT) is recommended, but programmatic experience is limited, particularly for adolescents.
METHODS
We conducted a prospective cohort study to describe MDR/RR-TB diagnosis and TPT provision for individuals aged <18 years with MDR/RR-TB exposure. Participants were assessed for TB either in homes or health facilities, with referral for chest x-ray or specimen collection at clinician discretion. The TPT regimens included levofloxacin, isoniazid, or delamanid monotherapy for 6 months, based on source patient drug-resistance profile.
RESULTS
Between March 1, 2020 and July 31, 2021, 112 participants were enrolled; median age was 8.5 years, 57 (51%) were female, and 6 (5%) had human immunodeficiency virus. On screening, 11 (10%) were diagnosed with TB: 10 presumptive MDR/RR-TB and 1 drug-susceptible TB. Overall, 95 (94% of 101) participants started TPT: 79 with levofloxacin, 9 with isoniazid, and 7 with delamanid. Seventy-six (80%) completed TPT, 12 (13%) were lost to follow up, and 7 (7%) stopped TPT early due to adverse events. Potential adverse events were reported for 12 (13%) participants; none were serious. There were no further TB diagnoses (200 days median follow up).
CONCLUSIONS
Post-MDR/RR-TB exposure management for children and adolescents resulted in significant MDR/RR-TB detection and both high TPT initiation and completion. Tuberculosis preventive monotherapy was well tolerated and there were no further TB diagnoses after initial assessment. Key factors supporting these outcomes included use of pediatric formulations for young children, monotherapy, and community-based options for assessment and follow up.
Journal Article > CommentaryFull Text
Lancet Child Adolesc Health. 2021 March 1; Volume 5 (Issue 3); 159-161.; DOI:10.1016/S2352-4642(21)00003-1
Mohr-Holland E, Douglas-Jones B, Apolisi I, Ngambu N, Mathee S, et al.
Lancet Child Adolesc Health. 2021 March 1; Volume 5 (Issue 3); 159-161.; DOI:10.1016/S2352-4642(21)00003-1